Person:
Chukwuma, Adanna

World Bank Health, Nutrition, and Population Global Practice

Fields of Specialization

HEALTH SYSTEM, HEALTH FINANCING, SERVICE DELIVERY, POLITICAL ECONOMY, ARMENIA, RUSSIA

ORCID

0000-0001-7873-7633

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Departments

World Bank Health, Nutrition, and Population Global Practice

Last updated: January 5, 2024

Biography

Adanna is a Senior Health Specialist in the Health, Nutrition, and Population Global Practice, where she leads the design, implementation, and evaluation of investment operations. She has over ten years of experience advising national reforms to improve access to high-quality health care, through service delivery organization, strategic purchasing, revenue mobilization, and demand generation, including in Sri Lanka, Sierra Leone, India, Moldova, Tajikistan, the South Caucasus Countries, and Romania. She has published on health care financing, access, and quality in peer-reviewed journals, including the Bulletin of the World Health Organization and Social Science and Medicine. Adanna obtained a medical degree from the University of Nigeria, a Master of Science in Global Health from the University of Oxford, and a Doctor of Science in Health Systems from Harvard University.

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Publication Search Results

Now showing 1 - 9 of 9

Provider Payment Reforms for Improved Primary Health Care in Romania
(World Bank, Washington, DC, 2021-08) Chukwuma, Adanna; Chen, Dorothee; Gong, Estelle
Romania faces high levels of amenable mortality reflecting, in part, the relatively low utilization rates of high-quality primary health care (PHC), particularly for non-communicable disease (NCD) prevention and treatment. Provider payment mechanisms do not reward the high-quality care provision and may incentivize bypassing of PHC for hospitals, exacerbating challenges presented by physical, financial, and social barriers to accessing essential care. This paper assesses provider payment mechanisms at the PHC level, by examining their design features and implementation arrangements, and exploring their implications for PHC performance in terms of access and quality of care. The authors conclude with policy recommendations to address the constraints identified. To increase the supply of preventative care and case management, the authors recommend that volume thresholds for fee-for-service payments reflect both the number of enrollees and physicians in a practice; laboratory tests required for case management be reduced in scope and their costs be reimbursed; and the law on health care reform be amended to enable the introduction of new payment mechanisms, such as performance-based payments. To expand the scope of PHC and strengthen care coordination with hospitals, periodic reviews by physician commissions should aim to expand the scope of PHC care in line with provisions in other European Union (EU) countries for ambulatory-care sensitive conditions; capitation payments should be adjusted for gender and historical service use to reduce incentive for over-referrals; and payment mechanisms that reward coordination of care, including bundled payments, should be introduced. To establish an enabling environment for provider payment reforms, health information systems should be strengthened by unifying diagnosis coding, establishing quality standards, and ensuring referral module functionality; payment reforms should be informed by extensive consultations with providers at all service delivery levels; and PHC spending should be increased to support higher reimbursement levels for providers and match expenditure levels in high-performing EU health systems.
FinHealth Armenia: Reforming Public Financial Management to Improve Health Service Delivery
(World Bank, Washington, DC, 2020-11-02) Gurazada, Srinivas; Chukwuma, Adanna; Jain, Manoj; Tsaturyan, Saro; Khcheyan, Makich
This report aims to assess public financial management (PFM) bottlenecks in health service delivery and identify recommendations for the Ministry of Health (MOH) and its partners in Armenia. This PFM assessment identifies health sector–specific bottlenecks and recommends actions that the MOH and regional (Marz) health authorities can take. Governments have a central role to play in moving countries toward universal health coverage. In low- and middle-income countries, making progress toward universal health coverage involves financing mechanisms that allow for coverage for the formal sector, the poor and the informal sector, to improve the coverage of quality health services. PFM systems, the way public budgets are formed, executed, and monitored interact with health system functions to influence service delivery outcomes. This study builds on a body of research that links improved service delivery outcomes in the health sector to systems for fiscal sustainability, operational efficiency, fiscal transparency, and accountability. The evidence supports the proposition that governance matters for the effective use of public resources in health service delivery.
More Money for Health: Resource Mobilization for Universal Health Coverage in Armenia
(World Bank, Washington, DC, 2021-12-20) Maduko, Franklin; Chukwuma, Adanna; Minasyan, Gevorg; Manookian, Armineh; Saldarriaga Noel, Miguel Angel; Tandon, Ajay
Armenia has made significant gains in population health, but faces challenges in ensuring health care access, due to financial barriers. As mortality caused by infectious diseases has fallen over the past two decades, the prevalence of noncommunicable diseases (NCDs) has increased. The NCD burden can be reduced via public health measures, such as tobacco control exposure, and access to high-quality health care. However, financial barriers to access are a significant challenge.
Macroeconomic Effects of Financing Universal Health Coverage in Armenia
(World Bank, Washington, DC, 2021-06-08) Dudu, Hasan; Chukwuma, Adanna; Manookian, Armineh; Aghazaryan, Anastas; Zeshan, Muhammad
Armenia has made significant progress in improving population health outcomes over the past two decades. However, essential health care for non-communicable diseases (NCDs) is underutilized in part due to the cost of access. Armenia has also committed as a signatory to the Sustainable Development Goals, to making progress towards Universal Health Coverage (UHC). This commitment involves guaranteeing access to essential health care for all its citizens. The Ministry of Health (MoH) has developed a concept note for the introduction for Universal Health Insurance that proposes to mobilize additional revenue through payroll taxes or higher budgetary allocations to the sector. However, the Ministry of Finance (MoF) has noted that revenue mobilization options should ideally demonstrate positive returns in terms of economic growth and employment. Therefore, at the request of the MoH, the World Bank has modeled the macroeconomic impacts of options to increase domestic resource mobilization to finance universal access to essential health services in the basic benefits package. The analysis assumes that through UHC reforms that mobilize additional public spending, the government would cover the cost of ninety-five percent of household needs for health care from 2021 to 2050, and that the increase in the demand for care will be supported by improvements in supply-side efficiency. The results suggest that increasing direct taxes is better than increasing indirect taxes as the former are less distortionary and cause smaller allocative inefficiencies.
The Impact of Health Taxes in Armenia
(Washington, DC: World Bank, 2023-09-14) Saxena, Akshar; Chukwuma, Adanna; Qaiser, Seemi; Manookian, Armineh; Minasyan, Gevorg
This report has been prepared by the World Bank, at the request of the MoH, to support ongoing efforts to improve population health and revenue mobilization in the sector. The study estimates the health impacts of increasing taxation on SSBs, alcohol, and tobacco across gender and income-quintiles. The revenue potential of these taxes is also explored. The target audience for these findings includes senior policymakers and technical advisers in the MoH, Ministry of Economy, and Ministry of Finance (MoF).The remainder of this report is organized as follows. In Chapter 2, the authors reviewthe current state of health and consumption taxes in Armenia. Chapter 3 outlines themethods used to estimate the change in tax revenue and consumption of alcohol,tobacco, and SSBs. Chapter 4 reports the analysis results, including the potentialadditional fiscal space and health gains. Finally, chapter 5 presents the conclusionsbased on the findings.
Reforming the Basic Benefits Package in Armenia: Modeling Insights from the Health Interventions Prioritization Tool
(World Bank, Washington, DC, 2021-03-26) Fraser, Nicole; Chukwuma, Adanna; Koshkakaryan, Marianna; Yengibaryan, Lusine; Hou, Xiaohui; Wilkinson, Tommy
Armenia is an upper-middle-income (UMI) country in the South Caucasus region. The Coronavirus (COVID-19) pandemic and a regional crisis have resulted in the real economy's contraction following rapid growth in the past five years. Improving access to high-quality health care is essential for responding to non-communicable diseases (NCDs) and preventing mortality from infectious diseases in Armenia. Armenia is faced with the challenge of achieving Universal Health Coverage (UHC) when funding for health services faces downward pressures due to a donor funding transition, the Coronavirus (COVID-19) pandemic, and regional conflict. This report is part of the World Bank’s technical support toward universal health coverage in Armenia, which includes advisory services and analytics aimed at supporting the government’s efforts to expand access to high-quality health care. The report draws on the Health Interventions prioritization tool to optimize allocations across essential health services in the basic benefits package and estimate the potential impact of these allocations on population health.
A Comparison of Health Achievements in Rwanda and Burundi
(FXB Harvard School of Public Health, 2018-06) Iyer, Hari S.; Chukwuma, Adanna; Mugunga, Jean Claude; Manzi, Anatole; Ndayizigiye, Melino; Anand, Sudhir
Strong primary health care systems are essential for implementing universal health coverage and fulfilling health rights entitlements, but disagreement exists over how best to create them. Comparing countries with similar histories, lifestyle practices, and geography but divergent health outcomes can yield insights into possible mechanisms for improvement. Rwanda and Burundi are two such countries. Both faced protracted periods of violence in the 1990s, leading to significant societal upheaval. In subsequent years, Rwanda’s improvement in health has been far greater than Burundi’s. To understand how this divergence occurred, we studied trends in life expectancy following the periods of instability in both countries, as well as the health policies implemented after these conflicts. We used the World Bank’s World Development Indicators to assess trends in life expectancy in the two countries and then evaluated health policy reforms using Walt and Gilson’s framework. Following both countries’ implementation of health sector policies in 2005, we found a statistically significant increase in life expectancy in Rwanda after adjusting for GDP per capita (14.7 years, 95% CI: 11.4–18.0), relative to Burundi (4.6 years, 95% CI: 1.8–7.5). Strong public sector leadership, investments in health information systems, equity-driven policies, and the use of foreign aid to invest in local capacity helped Rwanda achieve greater health gains compared to Burundi.
Challenges and Opportunities for Purchasing High-Quality Health Care: Lessons from Armenia
(Taylor and Francis, 2021-04-29) Lylozian, Hratchia; Chukwuma, Adanna; Gong, Estelle
This paper examines how purchasing decisions in Armenia may contribute to barriers in using high-quality health care, particularly for non-communicable diseases, drawing on a review of the literature and key informant interviews. The paper adapts the strategic health purchasing progress framework, to examine how characteristics of purchasing, the health system, and the political, administrative, and macro-fiscal environment may have facilitated or hindered the attainment of service delivery goals. We conclude with six lessons for reforms aimed at improving the coverage and quality of health care in Armenia. First, increasing the political priority of access to quality of health care is a pre-requisite to advancing reforms to address these issues. Second, improved purchasing governance in Armenia will require a purchaser that can make decisions without political interference, with appropriate accountability mechanisms, improvements in technical capacity, and the routine use of data systems. Third, there is a need for the regulatory framework to ensure that revisions of the benefits package contribute to reducing the disease burden and improving access to care. Fourth, regulations governing quality-related criteria for provider selection should be enforced and include considerations for process quality. Fifth, payment incentives should be revised to encourage an increase in the supply of primary health care, reduce bypassing for hospital care, and improve the quality of services. Sixth, the potential of purchasing to improve service delivery will be dependent on increased pre-paid and pooled funds and better governance of the quality of care.
Using Allocative Efficiency Analysis to Inform Health Benefits Package Design for Progressing towards Universal Health Coverage: Proof-of-Concept Studies in Countries Seeking Decision Support
(PLoS, 2021-11-29) Fraser-Hurt, Nicole; Hou, Xiaohui; Wilkinson, Thomas; Duran, Denizhan; Abou Jaoude, Gerard J.; Skordis, Jolene; Chukwuma, Adanna; Lao Pena, Christine; Tshivuila Matala, Opope O.; Gorgens, Marelize; Wilson, David P.
Countries are increasingly defining health benefits packages (HBPs) as a way of progressing towards Universal Health Coverage (UHC). Resources for health are commonly constrained, so it is imperative to allocate funds as efficiently as possible. We conducted allocative efficiency analyses using the Health Interventions Prioritization tool (HIPtool) to estimate the cost and impact of potential HBPs in three countries. These analyses explore the usefulness of allocative efficiency analysis and HIPtool in particular, in contributing to priority setting discussions.